Anatomical Chains

Andrew T. KimKaiser Permanente Spine Fellow-

2019

○ Why

○ Types

○ Formation

○ Approach

Objectives

○ Muscles do not function as independent units

Chains?

○ Biomechanical

○ Neuromuscular

○ Myofascial

Types of Chains

○ Structure, motion, and function of a task○ Timing and force along the chain will determine the performance of the task

■ I.e. throwing or squatting

Biomechanical Chain

○ Janda → NM chains from a developmental kinesiology perspective○ Tonic (Flexor) vs Phasic (Extensor) system

○ As neurodevelopmental progresses,

these chains co-activate for tasks:

■ Reaching

■ Grasping

■ Creeping

■ Crawling

■ Gait

Neuromuscular Chain

○ Upper Chain○ Tonic/Flexor

■ Shld flexion, IR, ADD, pronation

○ Phasic/Extensor

■ Shld extension, ER, ABD, supination

○ Lower Chain○ Tonic/Flexor

■ Hip flexion, IR, & ADD + ankle PF, INV

○ Phasic/Extensor

■ Hip extension, ER, & ABD + ankle DF, EV

Tonic vs Phasic Chains○ Functional tasks

○ Reaching

○ Grasping

○ Creeping

○ Crawling

○ Gait

○ Fascia - contains contractile cells,

free nerve endings, and mechanoreceptors

○ Tensegrity-like, bodywide network

○ Connective tissue ○ Surrounding the skeletal muscles has contractile features - 40%

○ Can modify both water content and its stiffness in response to mechanical stimuli

Myofascial Chain

○ Systematic review: What is evidence-based

about myofascial chains?○ Strong evidence

■ Superficial Back Line

■ Back Functional Line

■ Front Functional Line

○ Moderate evidence

■ Spiral Line

■ Lateral Line

○ Weak evidence

■ Superficial Front Line

Myofascial Chain

○ Superficial back line

○ Back functional line

○ Front functional line

Myofascial Back Chains

○ Superficial back line○ Galae aponeurotica/scalp fascia, erector spinae,

thoracolumbar+sacral fascia, sacrotuberous ligament,

hamstring muscle, gastrocnemius, achilles tendon,

plantar aponeurosis and short toe flexors

○ Back functional line

○ Front functional line

Myofascial Back Chains

Myofascial Back Chains○ Superficial back line

○ Galae aponeurotica/scalp fascia, erector spinae,

thoracolumbar+sacral fascia, sacrotuberous ligament,

hamstring muscle, gastrocnemius, achilles tendon, plantar

aponeurosis and short toe flexors

○ Back functional line○ Latissimus dorsi, thoracolumbar+sacral fascia,

contralateral glut max, vastus lateralis, subpatellar tendon

○ Front functional line

Myofascial Back Chains○ Superficial back line

○ Galae aponeurotica/scalp fascia, erector spinae,

thoracolumbar+sacral fascia, sacrotuberous ligament,

hamstring muscle, gastrocnemius, achilles tendon, plantar

aponeurosis and short toe flexors

○ Back functional line○ Latissimus dorsi, thoracolumbar+sacral fascia, contralateral

glut max, vastus lateralis, subpatellar tendon

○ Front functional line○ Pec major (lower edge), lateral sheath of rectus

abdominus, adductor longus

○ Superficial back line○ Galae aponeurotica/scalp fascia, erector spinae, thoracolumbar+sacral fascia,

sacrotuberous ligament, hamstring muscle, gastrocnemius, achilles tendon,

plantar aponeurosis and short toe flexors

Myofascial Chain

○ Grieve et al 2015 & Patel et al 2016○ Self-massage of the plantar foot increased hamstring extensibility

○ Wilke et al 2016○ Stretching the calf and hamstrings enhanced C/S mobility in the

sagittal plane

○ Montecinos-Cruz et al 2015○ Anterior pelvic tilt in long sitting demonstrated gastrocnemius

fascia to displace in the cranial direction

Myofascial Back Chains○ Back functional line

○ Latissimus dorsi, thoracolumbar+sacral fascia, contralateral glut max, vastus

lateralis, subpatellar tendon

○ Carvhalais et al 2013○ Passive lengthening of lat dorsi caused an altered hip position

and mechanical stiffness of hip muscles

Myofascial Back Chains○ Front functional line

○ Pec major (lower edge), lateral sheath of rectus abdominus, adductor longus

○ Fricker et al 1991, Anderson et al 2001, Morales-

Conde et al 2010, Choi et al 2011○ Groin pain in athletes (athletic pubalgia) → strength

imbalances between adductor longus and lower abdominal

muscles

○ Functional approach○ Find the key chain involved in the movement

■ Identify the “overactive link” → Inhibit

■ Identify the “weakest link” → Facilitate

○ Referred pain○ I.e. myofascial TrP of the calf →

sole of the foot and to dorsal thigh (Travell et al)

Approach

○ Concrete tailored interventions for pts with pain/impairments

○ Non-anecdotal

Future Research

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